HOSPITALISATION IN A NETWORK
HOSPITAL
Subject to pre-authorisation, case
management and clinical protocols

Intensive care and high-care wards

Ward accommodation

Theatre fees

Ward medicine

Consultations, surgery and anaesthesia

100% of the UPFS/ contracted/ scheme tariff/ medicine price/ cost
Unlimited
35% co-payment per admission if not pre-authorised, or for
non-emergency admission or voluntary admission to a
non-network hospital

STANDARD RADIOLOGY, PATHOLOGY
AND MEDICAL TECHNOLOGIST SERVICES
In hospital
Interventional procedures performed by a
radiologist

100% of the contracted/ scheme tariff/ medicine price/ cost
R23 400 per family per year

SPECIALISED RADIOLOGY
In and out of hospital
Only services requested by a specialist on
referral by a network GP and subject to
clinical protocols

MRI and CT-imaging (subject to pre-authorisation)

Angiography

100% of the contracted/ scheme tariff/ medicine price/ cost
R12 600 per family per year

OXYGEN
In hospital

100% of the contracted/ scheme tariff

CLINICAL TECHNOLOGIST SERVICES
In hospital

100% of the scheme tariff/ cost
R17 100 per family per year

DENTAL PROCEDURES UNDER GENERAL
ANAESTHESIA
In a network hospital and prescribed by a
Denis network dental practitioner
Subject to pre-authorisation and Denis
managed care protocols

100% of the Medihelp Dental Tariff
Only PMB services and extensive dental treatment for
children younger than 5 years – once per lifetime
35% co-payment per admission if not pre-authorised or in case of
voluntary admission to a non-network hospital

100% of the contracted tariff/ medicine price/ cost
R20 200 per confinement for an elective caesarean
section
35% co-payment per admission if not pre-authorised or in case of
voluntary admission to a non-network hospital

PMB cases*

Hospitalisation

Midwifery and confinement/ delivery

Gynaecologist and anaesthetist services

Post-natal services

100% of the contracted tariff/ medicine price/ cost
Unlimited
35% co-payment per admission if not pre-authorised or in case of
voluntary admission to a non-network hospital

HOME DELIVERY
Subject to pre-authorisation and clinical
protocols

Professional nursing fees

Equipment

Material and medicine

100% of the scheme tariff/medicine price/cost
R10 100 per event
35% co-payment per event if not pre-authorised

SUB-ACUTE CARE AND PRIVATE NURSING
SERVICES AS AN ALTERNATIVE TO
HOSPITALISATION
Subject to pre-authorisation, and services
prescribed by a medical doctor
(Excluding general day-to-day care)

100% of the contracted/ scheme tariff/ medicine price/
cost
R17 100 per family per year
35% co-payment per admission if not pre-authorised

RENAL DIALYSIS (PMB ONLY)
Subject to pre-authorisation and clinical
protocols
In and out of hospital

Acute dialysis

Chronic/ peritoneal dialysis

100% of the contracted/ scheme tariff/ cost

PSYCHIATRIC TREATMENT OF A MENTAL HEALTH CONDITION (PMB ONLY)
Subject to pre-authorisation, and services
must be rendered in an approved hospital/facility and must be requested by a Necesse
network GP or a specialist on referral by a
network GP

Professional services rendered by a
psychiatrist in and out of hospital

Full-time scholars/students at a school/
tertiary institution
(Members without dependants)

Notice/letter on an official letterhead of the school/
tertiary institution where the member is registered as a
full-time student/scholar
Copy of member’s student card for the particular year

* Only official bank statements indicating the account holder’s initials and surname will be accepted. Please indicate clearly which payments/deposits refer to your income.

This is a summary of the available benefits. In the event of a dispute the registered Rules of Medihelp will apply, subject to approval by the Registrar of Medical Schemes. If a beneficiary joins during the course of a financial year, the benefits are calculated pro rata according to the remaining number of months per year. Phone Medihelp on 086 0100 678 if you have any enquiries about the Rules of Medihelp.

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